Sex differences in catheter ablation of atrial fibrillation: Results from AXAFA-AFNET 5

Mariëlle Kloosterman, Winnie Chua, Larissa Fabritz, Hussein R. Al-Khalidi, Ulrich Schotten, Jens C. Nielsen, Jonathan P. Piccini, Luigi Di Biase, Karl Georg Häusler, Derick Todd, Lluis Mont, Isabelle C. Van Gelder, Paulus Kirchhof

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Aims: Study sex-differences in efficacy and safety of atrial fibrillation (AF) ablation. Methods and results: We assessed first AF ablation outcomes on continuous anticoagulation in 633 patients [209 (33%) women and 424 (67%) men] in a pre-specified subgroup analysis of the AXAFA-AFNET 5 trial. We compared the primary outcome (death, stroke or transient ischaemic attack, or major bleeding) and secondary outcomes [change in quality of life (QoL) and cognitive function] 3 months after ablation. Women were older (66 vs. 63 years, P < 0.001), more often symptomatic, had lower QoL and a longer history of AF. No sex differences in ablation procedure were found. Women stayed in hospital longer than men (2.1 ± 2.3 vs. 1.6 ± 1.3 days, P = 0.004). The primary outcome occurred in 19 (9.1%) women and 26 (6.1%) men, P = 0.19. Women experienced more bleeding events requiring medical attention (5.7% vs. 2.1%, P = 0.03), while rates of tamponade (1.0% vs. 1.2%) or intracranial haemorrhage (0.5% vs. 0%) did not differ. Improvement in QoL after ablation was similar between the sexes [12-item Short Form Health Survey (SF-12) physical 5.1% and 5.9%, P = 0.26; and SF-12 mental 3.7% and 1.6%, P = 0.17]. At baseline, mild cognitive impairment according to the Montreal Cognitive Assessment (MoCA) was present in 65 (32%) women and 123 (30%) men and declined to 23% for both sexes at end of follow-up. Conclusion: Women and men experience similar improvement in QoL and MoCA score after AF ablation on continuous anticoagulation. Longer hospital stay, a trend towards more nuisance bleeds, and a lower overall QoL in women were the main differences observed.

Original languageEnglish (US)
Pages (from-to)1026-1035
Number of pages10
Issue number7
StatePublished - Jul 1 2020


  • Catheter ablation
  • Cognitive function
  • Complications
  • Efficacy
  • Female gender
  • Quality of life
  • Safety
  • Sex differences

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


Dive into the research topics of 'Sex differences in catheter ablation of atrial fibrillation: Results from AXAFA-AFNET 5'. Together they form a unique fingerprint.

Cite this